Desired Treatment Outcomes Research Articles

The Impact of Treatment Volumes of Psychiatric Clinics on the Risk for Applying Seclusion or Restraint

To determine the effect of treatment volumes on the frequency and duration of special safety measures (SSM) such as seclusion or restraint. Register Data of the Lower Saxony Ministry of Social Affairs, Health and Equal Opportunities is analysed for the number of cases hospitalised under State Mental Health Act, the proportion of cases experiencing SSM, and the frequency and cumulative duration of SSM per case. The larger the treatment volume of cases that are hospitalised under State Mental Health Act, the smaller the proportion of cases experiencing SSM. This result is robust, even if statistical outliers are exempted from analyses. In light of indications that also in mental health care treatment volumes may be related to the desired treatment outcome, discussion is need about the tension between hospital care that is provide.

Living With Inflammatory Bowel Disease: Online Surveys Evaluating Patient Perspectives on Treatment Satisfaction and Health-Related Quality of Life.

The quality of life of persons living with inflammatory bowel disease (IBD) is impacted by the physical and psychosocial burdens of disease, as well as by their satisfaction with the quality of care they receive. We sought to better understand (1) the drivers of satisfaction with treatment, including treatment goals, treatment selection, and attributes of patient/health care professional (HCP) interactions, and (2) how IBD symptoms affect aspects of daily life and overall quality of life. Two online questionnaires were accessed via MyCrohnsAndColitsTeam.com. The Treatment Survey assessed desired treatment outcomes, past and present therapies, and experiences with the patient's primary treating HCP. The Quality of Life survey assessed respondents' most problematic IBD symptoms and their influence on family and social life, work, and education. Respondents had Crohn's disease (CD) or ulcerative colitis (UC), were 19 years or older, and resided in the United States. All responses were anonymous. The Treatment Experience survey was completed by 502 people (296 CD, 206 UC), and the Quality of Life survey was completed by 302 people (177 CD, 125 UC). Reduced pain, diarrhea, disease progression, and fatigue were the most desired goals of treatment. Biologics and 5-aminosalicylates were reported as a current or past treatment by the greatest proportion of patients with CD and UC, respectively. A numerically lower proportion of respondents with UC than CD reported use of biologic or small molecule therapy; conversely, a numerically greater proportion of respondents with UC than CD reported these drugs to be very or extremely effective. The HCP was key in the decision to switch to, and in the selection of, biologic or small molecule therapy. Overall satisfaction with an HCP was greatly driven by the quality and quantity of the communication and of the time spent with the HCP. Troublesome abdominal symptoms most impacted aspects of social and family life. Emotional challenges associated with IBD were experienced by most respondents. Treatment goals of respondents seem to align with HCPs overall treatment goals, including control of gastrointestinal symptoms and prevention of disease progression. Persons with UC might be offered biologic and small molecule therapies less often, despite reported high efficacy by users. Feeling heard and understood by the HCP are key drivers of treatment satisfaction. Quality communication in the patient/HCP relationship enables a better understanding of the patients' goals, disease burden, and emotional needs, which are all key factors to consider when developing a personalized and comprehensive treatment plan and optimizing quality of life.

Heritability of maxillary dental cephalometric variables among monozygotic twins, dizygotic twins and their siblings.

The purpose of this study was to investigate the heritability of dental cephalometric variables by analyzing vertical linear measurements and angular measurements of the upper incisor, canine, and first molar. Among the 553 Korean patients who participated in twin studies conducted at Samsung Medical Center, 150 patients had their lateral cephalometric radiograph data included in this study. The group was comprised of 36 monozygotic (MZ) twins (males, 16 pairs; females, 20 pairs), 13 dizygotic (DZ) twins (males, 7 pairs; females, 6 pairs), and 26 same-sex sibling pairs (males, 11 pairs; females, 15 pairs). All patients were over 20years old with a mean age of 39.75years. Lateral cephalometric diagrams and linear measurements (6 vertical factors, 6 horizontal factors) were taken. Three axial planes were measured for each tooth; intraclass correlation coefficients (ICCs) were obtained for each group and heritability was calculated using Falconer's method. ICCs of vertical linear measurements (average 0.837, P < 0.01) and the tooth axis of the central incisor and canine (average 0.679, P < 0.001) were higher in the MZ group compared to the DZ and sibling groups; thus, these variables showed high heritability. Orthodontic treatment aiming to alter the tooth axis of the maxillary central incisor or canine or other vertical factors with greater heritability can be difficult, requiring strategic treatment planning to achieve desired treatment outcome and stability. The active early treatment to gain tooth eruption space can lead to normal tooth position.

Medication Adherence of Vietnamese Outpatients with Chronic Diseases during the COVID-19 Pandemic.

The purpose of this study was to determine the medication adherence of outpatients with chronic diseases and the association between both patient attitudes and preventive practices regarding COVID-19 and their medication adherence. We performed a cross-sectional study in Vietnam. Medication adherence was determined using the translated and validated Vietnamese version of the General Medication Adherence Scale (GMAS). Patient attitudes and preventive practices regarding COVID-19 were measured using the 5K message of the Vietnam Ministry of Health (facemasks, disinfection, distance, no gatherings, health declarations). The associations between patient characteristics and medication adherence were determined by multivariable regression. The study included 1852 outpatients, and 57.6% of the patients adhered to their medications. Patients who recognized the pandemic’s obstruction of medical follow-ups (OR = 1.771; 95%CI = 1.461–2.147; p < 0.001), who applied ≥2 preventive methods (OR = 1.422; 95%CI = 1.173–1.725; p = 0.001), who were employed (OR = 1.677; 95%CI = 1.251–2.248; p = 0.001), who were living in urban areas (OR = 1.336; 95%CI = 1.090–1.637; p = 0.005,) who possessed higher education levels (OR = 1.313; 95%CI = 1.059–1.629; p = 0.013), or who had ≤2 comorbidities (OR = 1.293; 95%CI = 1.044–1.600; p = 0.019) were more likely to adhere to their medications. The adherence percentage for outpatients with chronic diseases was quite low during the pandemic. Patients who did not recognize the COVID-19 pandemic’s obstruction of medical follow-ups or who had poor preventive practices were less likely to adhere to medications. Healthcare providers should pay more attention to these groups to achieve desired treatment outcomes.

The Effect of Low-Level Laser Therapy in Combination with Leukocyte- and Platelet- Rich Fibrin on Bone Regeneration in Rabbits' Calvarial Defects: Histologic and Histomorphometric Studies.

Bone regeneration is a desired treatment outcome in implant dentistry. The primary goal of the current investigation was to assess the joint effect of low-level laser therapy (LLLT) and leukocyte- and platelet-rich fibrin (PRF) on new bone formation. During this experiment study, forty bone defects (8 mm in diameter) were generated in the calvaria of ten New-Zealand white rabbits. defects were filled with autogenous bone defined as the control group, autogenous bone with leukocyte- and PRF (PRF group), autogenous bone and low-level diode laser radiation (LLLT group), and autogenous bone with leukocyte- and PRF and low-level laser radiation (LP group). Laser irradiation was done every second day for 2 weeks after surgery. Five rabbits were randomly selected to be sacrificed on postoperative weeks 4 and 8. On one and two-month post-surgery, histological and histomorphometric parameters including bone formation, fibroblast, and osteoblast were assessed. The histological panel depicted that the ratio of fresh bone formation increased at one-and two-month postsurgery in all treatment groups compared to the control group. The most favorable results were seen in the LP group, followed by the PRF group. Based on the ANOVA test, bone neoformation was statistically significant in the LP group in comparison with the control group (P<0.001). One-month post-surgery, a higher degree of fibroblast was seen in the control group, while the last place was for LP group (118.6 ± 6.9 vs. 24.0 ± 3.2). In the PRF group, the percentage of bone formation was higher than that in the control group (13.2 ± 2.8 vs. 2.0 ± 1.2), but no significant difference when compared to the LP group (13.2 ± 2.8 vs. 19.0 ±.3.8). The combined L-PRF and LLLT was more likely to have a positive effect on accelerating bone regeneration and reducing fibrosis.

Augmented reality application in prosthodontics

Augmented reality refers to: “a technology that superimposes a computer-generated image on a user’s view of the real world, thus providing a composite view”. It has become resourceful in many fields including dentistry and medicine. Currently augmented reality is restricted to education, maxillofacial surgeries and implantology but further research and development can expand its uses to many other critical areas. In prosthodontics, visualization of a smile design or a prosthesis outcome becomes difficult to the patient. Augmented reality will make it easier for all the persons involved to establish a proper communication and desired treatment outcome for the patient as it will superimpose the desired outcome on the current patient situation. As augmented reality is becoming more common, its applications will become wider. This article presents a brief history of the development of augmented reality and its current applications in the field of prosthodontics.

The parent trap: desire for multifetal gestation among patients treated for infertility.

ObjectiveTo evaluate predictors for patient preference regarding multifetal or singleton gestation among women presenting for infertility care.DesignCross-sectional study.SettingAcademic university hospital-based infertility clinic.Patient(s)Five hundred thirty-nine female patients with infertility who presented for their initial visit.Main outcome measure(s)Demographic characteristics, infertility history, insurance coverage, desired treatment outcome, acceptability of multifetal reduction, and knowledge of the risks of multifetal pregnancies were assessed using a previously published 41-question survey. Univariate analysis was performed to assess patient factors associated with the desire for multiple births. Independent factors associated with this desire were subsequently assessed by multivariate logistic regression analysis.Result(s)Nearly a third of women preferred multiples over a singleton gestation. Nulliparity, lower annual household income, older maternal age, marital status, larger ideal family size, openness to multifetal reduction, and lack of knowledge of the maternal/fetal risks of twin pregnancies were associated with pregnancy desire. Older age (OR (95% CI) 1.66 (1.20–2.29)), nulliparity (OR (95% CI) 0.34 (0.20–0.58)), larger ideal family size (OR (95% CI) 2.34 (1.73–3.14)), and lesser knowledge of multifetal pregnancy risk (OR (95% CI) 0.67 (0.55–0.83)) were independently associated with desire.Conclusion(s)A large number of patients undergoing fertility treatment desire multifetal gestation. Although a lack of understanding of the risks associated with higher order pregnancies contributes to this desire, additional individual specific variables also contribute to this trend. Efforts to reduce the incidence of multiples should focus not only on patient education on comparative risks of multiples vs singleton pregnancies but also account for individual specific reservations.

The role of health facility and individual level characteristics on medication adherence among PLHIV on second-line antiretroviral therapy in Northeast Ethiopia: use of multi-level model

BackgroundMedication adherence plays a pivotal role in achieving the desired treatment outcomes. The proportion of HIV patients on second-line antiretroviral therapy is becoming a growing public health concern. However, to date, little attention has been given to second-line antiretroviral medication adherence. Moreover, the association between health facility characteristics and medication adherence has yet not been tested. Thus, this research was conducted to determine the magnitude of medication adherence and examine the role of facility-level determinants among HIV patients on second-line ART.MethodsA cross-sectional study was conducted on 714 HIV patients on second-line therapy who were selected via systematic random sampling in twenty public health facilities. Medication adherence was measured using the six-item Simplified Medication Adherence Questionnaire (SMAQ) tool. Data were collected in a personal interview as well as document reviews. A multi-level binary logistic regression was used to uncover individual and facility-level determinants. The effect size was presented using an adjusted odds ratio (AOR), and statistical significance was declared at a P value less than 0.05.ResultsThe magnitude of optimal medication adherence among HIV patients on second-line antiretroviral therapy was 69.5% (65.9–72.7%). Medication adherence was positively associated with the use of adherence reminder methods [AOR = 3.37, (95% CI 2.03–5.62)], having social support [AOR = 1.11, (95% CI 1.02–1.23)], and not having clinical depression [AOR = 3.19, (95% CI 1.93–5.27). The number of adherence counselors [AOR = 1.20, (95% CI 1.04–1.40)], teamwork for enhanced adherence support [AOR = 1.82, (95% CI 1.01–3.42)], and caseloads at ART clinics were all significantly correlated with ARV medication adherence at the facility level.ConclusionsA large proportion of HIV patients on second-line antiretroviral therapy had adherence problems. Both facility-level and individual-level were linked with patient medication adherence. Thus, based on the identified factors, individual and system-level interventions should be targeted.

P239 Ulcerative Colitis Index of Severity is a better predictor of histologic activity than Mayo endoscopic subscore, an Asian cohort study in ulcerative colitis

Abstract Background Targets of therapy in ulcerative colitis (UC) have undergone a shift from clinical remission to endoscopic healing (EH). Recent STRIDE II guidelines1 have recommended stricter criteria for EH, Ulcerative Colitis Index of Severity (UCEIS) ≤1 or Mayo endoscopic subscore (MES)=0, with histologic healing (HH) as an adjunctive endpoint. We aim to ascertain the strength of correlations between EH and HH using validated indices in an Asian cohort. Methods A single-centre cohort study was performed in a tertiary centre. Patients with a diagnosis of UC were prospectively enrolled into a database from January 2017 to June 2020. Patient demographics, clinical classification, endoscopic and histological assessments were collected retrospectively and analysed. Endoscopic scores in the worst affected segments by two independent gastroenterologists. Histological activity was assessment by a single gastrointestinal histopathologist using the Nancy Histological Index (NHI). Analysis was done using SPSS v23. Spearman correlations between UCEIS, MES and NHI was performed. Results A total of 88 patients with UC were enrolled (Figure 1). Seven patients were excluded as no biopsies were done during endoscopy. Analysis was done for 163 pairs of endoscopy and histology. The distribution of UCEIS, MES and NHI scores for all endoscopies are shown in Figure 2. Both MES and UCEIS had modest correlations with NHI but UCEIS had a stronger correlation to NHI (r=0.640, p&amp;lt;0.01) than MES (r=0.538, p&amp;lt;0.01) (Figure 3). When evaluating patients in EH (UCEIS≤1 or MES=0), both endoscopic scores had similar distribution of NHI scores (Figure 4a &amp; 4b). Despite appearing to be endoscopically inactive, more than half of patients had histologically active disease, with NHI≥2 (14/27 [51.8%] in the UCEIS≤1 group, 9/17 [52.9%] in the MES=0 group). When using the older definition of EH (MES≤1), 49 of 66 patients (74%) had histologically active disease with NHI≥2 (Figure 4c). Conclusion UCEIS ≤1 is slightly more predictive of HH than MES=0 but endoscopic correlation with HH is poor. Biopsies should still be performed if HH is a desired treatment outcome. The more stringent criteria change for EH in STRIDE II from MES≤1 to MES=0 results in higher rates of HH. Reference 1. Turner D, et al.; International Organization for the Study of IBD. STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organization for the Study of IBD (IOIBD): Determining Therapeutic Goals for Treat-to-Target strategies in IBD. Gastroenterology. 2021 Apr;160(5):1570–1583.

Parental Attitude and Awareness of the Use of Complementary and Alternative Medicine for the Management of Respiratory Tract Infections in Children: A Cross-Sectional Study from Aseer Region, Saudi Arabia

Respiratory tract infections are considered the major cause of pediatric hospitalization requiring direct supervision by a clinician. The use of antibiotics that are commonly used for treatment is sometimes associated with the development of antibiotic resistance and less than desirable treatment outcome. Despite limited clinical evidence, complementary and alternative medicine is widely used as an alternative to antibiotics worldwide for treatment of respiratory tract infections in children. Therefore, we decided to explore the parental attitude and awareness regarding the use of the complementary and alternative medicine for the management or prevention of respiratory tract infections in children in Aseer region, Saudi Arabia. Over a 4-month period during influenza season, 1,192 parents were administered two sets of seven questionnaires dealing with attitude and awareness about the complementary and alternative medicine use. The results show that parents who felt that respiratory tract infections in children do need antibiotics supported the use of the complementary and alternative medicine modalities. More than half of the participants agreed that the complementary and alternative medicine would produce fewer side effects on their children's immunity than antibiotics and produce less bacterial resistance. In conclusion, the complementary and alternative medicine use for the treatment of respiratory tract infections in children should be based only on reliable and evidence-based advice.

Personalised nitinol stent for focal plaques: Design and evaluation

The purpose of this study is to develop personalised nitinol stents for arteries with one and two opposite focal plaques. Novel designs are evaluated through comparison with a commercial stent design, in terms of lumen gain and shape as well as stress levels in the media layer after stenting. Methods: Personalised stents are developed for arteries with one and two opposite focal plaques, based on medical imaging of patients and computer simulations. In silico analysis is then carried out for assessment of stent performance in the diseased arteries. Results: Personalised designs significantly increase the lumen gain, reduce the stresses in the media layer, and improve the lumen shape compared to the commercial nitinol stent. Conclusion: The personalised designs show outstanding performance compared to the commercial stent. Significance: This pilot study proves that personalised nitinol stents are able to deliver desirable treatment outcomes.

Regenerative Endodontic Therapy Using Platelet-Rich Plasma (PRP) and Amelogenin for the Treatment of Non-vital Immature Permanent Teeth with Apical Periodontitis: An Animal Study

Background: Platelet-rich plasma (PRR) was proposed to serve as a possible scaffold model for regenerative endodontic therapies. However, its treatment outcomes are still controversial. Amelogenin protein has been shown to induce stem cell proliferation and differentiation. Thus, the aim of this study was to investigate whether the addition of amelogenin to PRP in non-vital immature permanent teeth with apical periodontitis can improve their treatment outcomes. Methods: Root canals of both maxillary and mandibular premolars in 8 mongrel dogs (n= 128) were instrumented and left open. After 14 days, in a second surgical procedure, canals were cleaned, irrigated, and treated with PRP (n=64) and PRP + amelogenin (n=64). After 1 and 3 months, animals were killed, and treated teeth were evaluated for histological and immune detection for nestin markers. Results: After 1 and 3 months post-surgery, PRP-treated canals showed full closure of opened apexes but minimal cementum, periodontal ligament (PDL), and bone regeneration. Importantly, no pulp regeneration was recognized. In contrast, PRP + amelogenin-treated canals at 1 and 3 months showed full closure of opened apexes, significant deposition of cementum, bone, regeneration of PDL, and pulp-like tissue regeneration compared to PRP-treated groups (p&lt;0.001). By the 3-month period, full regeneration of all the lost dental-pulp complex tissues was seen, including vascular pulp-like tissue. Conclusions: PRP alone did not achieve the desired treatment outcomes, but after addition of amelogenin protein, it induced pulpal regeneration and regenerated the whole attachment apparatus. This combination could serve as a novel approach for regenerative endodontic therapy in non-vital immature permanent teeth with apical periodontitis. However, additional research is warranted to further evaluate the effect of such a combination in different animal settings before administrating this approach in clinical cases.

Role of Imaging in Prostate Artery Embolization

Abstract Benign prostatic hyperplasia is a common condition affecting elderly men and leading to lower urinary tract symptoms (LUTS). Prostatic artery embolization (PAE) is a minimally invasive treatment option performed by interventional radiologists, which is emerging as a safe and effective alternative to traditional surgical options in the management of men with LUTS. A detailed understanding of pelvic arterial anatomy, its variations and anastomosis is imperative to perform this procedure safely and to achieve desired treatment outcomes. Advanced imaging techniques which include fluoroscopy, subtraction angiography and cone-beam computed tomography have become standard practice when performing PAE. In this article, the authors focus on the role of imaging in preoperative, intraoperative and postoperative settings while planning and performing prostate artery embolization.

3D Printed Housing Devices for Segregated Compartmental Delivery of Oral Fixed-Dose Anti-Tubercular Drugs Adopting Print and Fill Strategy.

World Health Organization (WHO) recommends the use of first-line anti-tuberculosis drugs, that is, rifampicin (RIF) and isoniazid (INH) fixed-dose combination (FDC) therapies in tuberculosis (TB) disease. The absorption of RIF from an FDC incorporates INH, and it is significantly compromised due to its reaction with INH, resulting in a severe loss of RIF under gastric stomach pH condition. Such reduction in the dose of both drugs from FDC formulations has been alleged to be one of the chief obstacles in effective TB treatment. This emphasizes a need to develop suitable cutting-edge advanced bioengineered delivery devices that can attenuate this severe problem to mitigate this chief obstacle. Therefore, we designed, prototyped, and characterized bioengineered 3D printed housing devices in the form of printed tablets adopting print and fill strategy for segregated compartmental delivery of RIF into the intestine (to avoid stomach gastric pH induced chemical degradation as alone and FDC) and INH into the stomach (no degradation observed as alone and FDC in stomach gastric pH conditions) for the desired treatment outcome against TB. Prepared 3D printed housings showed almost zero friability, enough hardness along weight variations <±3.0%. Different thermal and morphological analyses confirmed the insignificant changes in the nature of the polymer as before and after printing. The in vitro release for INH from polyvinyl alcohol mediated 3D printed housings showed almost 100% release within 2.5 h in acidic medium, whereas poly-lactic acid (PLA) mediated 3D printed housings continued to release RIF above 70% in the presence of physiological enzymes in alkaline medium for 432 h. The in vivo bioavailability assessment correlated with in vitro dissolution behavior for INH and RIF, whereas RIF did not release from 3D printed PLA housings in vivo.

Racial/Ethnic Variations in Acne: Implications for Treatment and Skin Care Recommendations for Acne Patients With Skin of Color.

Acne vulgaris is among the most common dermatologic diagnoses observed, including skin color (SOC) populations. This project sought to help clarify the existing published data and provide consensus statements on acne presentation, prevention, treatment, and maintenance in SOC populations to help improve patient outcomes. Six SOC dermatologists convened for a virtual meeting and used a modified Delphi process to address: 1) Are there racial/ethnic differences in the clinical presentation and sequela of acne? 2) Are there racial/ethnic differences in the therapeutic endpoint of acne treatment and patient expectations? 3) Is there a need for specialized approaches to therapeutic options and skincare in acne patients with SOC? The results of a literature review and the outcome of discussions, coupled with the panel's expert opinion and experience, are intended for health care providers caring for acne patients and clinician-researchers. Racial/ethnic differences in the clinical presentation, sequelae, and desired treatment outcomes for acne have been reported. Notwithstanding limitations in the number, size, and methodologies of studies to date, the available data suggest that strategies that improve outcomes in acne patients with SOC include: Early initiation and maintenance of treatment regimens and careful consideration of tolerability of active ingredients, vehicles, and dosing. Using pH-balanced, non-irritating cleansers and non-comedogenic ceramides containing moisturizers help minimize irritation or dryness. There a need for specialized approaches to therapeutic options and skincare in acne patients with SOC. OTC skincare products are recommended before and during prescription therapy and as part of a maintenance regimen. J Drugs Dermatol. 2021;20(7):716-725. doi:10.36849/JDD.6169 THIS ARTICLE HAD BEEN MADE AVAILABLE FREE OF CHARGE. PLEASE SCROLL DOWN TO ACCESS THE FULL TEXT OF THIS ARTICLE WITHOUT LOGGING IN. NO PURCHASE NECESSARY. PLEASE CONTACT THE PUBLISHER WITH ANY QUESTIONS.

A retrospective study of drug related problems and contributing factors among type 2 diabetes mellitus patients on follow up at public health institutions of kemisse town, north east Ethiopia

BackgroundDrug related problems interfere with the desired treatment outcomes of type 2 Diabetes mellitus. This study was conducted to determine prevalence of drug related problems and associated factors among patients with type 2 Diabetes Mellitus in public health institutions of Kemisse town, northeast Ethiopia from May 01 to 30, 2019. MethodsInstitution based retrospective cross sectional study was conducted among type 2 Diabetes Mellitus patents on follow up at public health institutions of Kemisse town, northeast Ethiopia. ResultFrom the total of 156 patients included in the study, 126 (80.8%) patients have at least one drug related problem with a total of 149 drug related problems. The most prevalent drug related problems were need for additional drug therapy 60 (40.3%) followed by non-compliance 51 (34.2%) and unnecessary drug therapy 12 (8%). Identified causes of need for additional drug therapy were the need for prophylactic drug therapy (statins and antiplatelet), 83.3%; presence of untreated medical condition (Hypertension, diabetic nephropathy and diabetic foot ulcer), 11.7%; and the need for combination therapy for better efficacy, 5%. This study revealed that age ≥45 years (AOR = 5.59, 95% CI = 1.38–20.64, P = 0.016), presence of comorbid condition (AOR = 3.22, 95% CI = 1.75–13.47, P = 0.014 and emergency visit in the last one year (AOR = 5.08, 95% CI = 1.14–18.71, P = 0.033) were significantly associated with the occurrence of drug related problems. ConclusionA total of 149 drug related problems were identified in 80.8% of type 2 diabetes mellitus patients. The three most prevalent drug related problems were need for additional drug therapy 60 (40.3%) followed by non-compliance 51 (34.2%) and unnecessary drug therapy 12 (8%). Additionally, age ≥45 years (AOR = 5.59, P = 0.016), presence of comorbidity (AOR = 3.22, P = 0.014) and emergency visit in the last one year (AOR = 5.08, P = 0.033) were significantly associated with the occurrence of drug related problem.

PCN208 Association of Quality of Life with Oncology Medication Adherence in Cancer Patients on the Service of a Specialty Pharmacy

Specialty pharmacy drugs (SP-D) are high-cost and for the treatment of complex conditions, e.g., cancer (O). High medication adherence and quality of life (QoL) contribute to desired treatment outcomes. SP Medication Therapy Management (SPMTM) contributes to optimal QoL and adherence; therefore, the objective is to compare adherence to oral O-SP-D with QoL metrics reported by O patients who participated in SPMTM before and after Start of Care (SOC).

ICF linking of patient-reported therapy goals for children with acquired upper extremity impairment

BackgroundPatient reported outcome measures are used to evaluate hand therapy outcomes. Yet, limited evidence is available regarding the outcomes children desire from hand therapy. PurposeTo determine the desired treatment outcomes of children with acquired upper extremity impairments. Study designDescriptive case series MethodsTwo raters independently applied International Classification of Function, Disability and Health (ICF) linking rules to the Canadian Occupational Performance goals of 151 children, age 6-18, receiving occupational therapy for acquired upper extremity impairments. Prevalence of the linked ICF codes was examined using frequency distributions. Kappa and the proportion of positive agreement assessed inter-rater agreement of the linked codes. ResultsFollowing consensus, two independent raters linked 894 meaningful concepts to the study population's 501 goals derived from the Canadian Occupational Performance. Ninety-two unique ICF codes were linked to these 894 meaningful concepts. Twenty-three ICF codes account for 77.2% of the most frequently linked codes. For these top 23 codes, the greatest proportion (51.4%) of ICF codes are in the d4 mobility chapter representing specific constructs of hand and arm use. The second largest proportion (14.2%) of linked codes are in the d9 Community, society and civic life chapter aligning with participation in sports, music, performing arts and play. Within the d5 self-care chapter, the study population's top priorities included hair care, fitness and drinking. The primary concerns within the b body functions domain are reduced pain, improved joint mobility and strength. ConclusionThe study population's top priorities align with specific dimensions of hand and arm use and participation in sports and fitness, performing arts, and play. Further research may elucidate alignment of these patient-desired outcomes and the item banks of commonly used patient reported outcome measurement scales in this population.

Familial perceptions of appropriate treatment types and goals for a family member who has opioid use disorder

BackgroundDespite effective, evidence-based medications for opioid use disorder (MOUD), these treatments remain underutilized. This may be due to multiple reasons. Family members may impact patient decision-making when choosing an opioid use disorder (OUD) treatment. While there has been work on patient preferences and attitudes towards opioid use disorder (OUD) treatment, to date, there has been minimal work assessing the attitudes of family member towards OUD treatment and recovery. MethodsParticipants were ≥ 18 years of age and endorsed having a first-degree family member with past-year treatment for OUD. Participants were recruited via online crowdsourcing and were asked a number of questions regarding their desired outcomes for OUD treatment, and their familiarity, approval, and perceived effectiveness of various OUD treatment options. ResultsThe most commonly reported desired treatment outcome (50 %) was for family members to never use any kind of opioid, including maintenance therapies or opioid analgesics. Mean familiarity ratings for MOUD (rated 0–100) were relatively low, with naltrexone being the least familiar (32.3). Among those who endorsed a familiarity rating of at least 30 for a given treatment, mean approval and effectiveness ratings were relatively low—buprenorphine (approve 55.1; effective 54.1), methadone (approve 51.9; effective 49.3), naltrexone (approve 61.6; effective 55.9). These were lower than approval and effectiveness ratings for all non-MOUD treatments queried. ConclusionsThese findings highlight a need for clinicians and researchers to engage with family members’ regarding their preferences and understanding of treatment, and to better understand how this might impact patient engagement with treatment.

Concept of value-based healthcare

This article contains the aims and main principles of the concept of value-based healthcare (VBHC). The relevance of the implementation of this approach into the Russian healthcare system results from the fact that during the control and payment for medical care, the treatment outcomes are evaluated selectively and at separate stages. The medical care payment system considers only its volumes and not achieving the desired treatment outcome significant to a patient. A review of the world’s best practices of introducing VBHC conception and, also new medical care payment methods such as bundled payment and pay-for-performance (P4P) has been conducted. According to international experience, VBHC increases the quality of medical care and provides the optimization of costs. To implement VBHC model in the Russian Federation, it is necessary to ensure the informatization of the providing medical care, development, and improvement of medical quality control systems (development of the resulting criteria for medical care quality for all diseases), and introduction of the rating system for medical organizations. Provided these processes are ensured, further progressing to P4P is possible. Moreover, it would also be feasible to implement VBHC in other healthcare processes including procurement of drugs and medical devices, their pricing, and reimbursement.